Direct-pay doctors revive a dying art

A thin column of steam rises from a 12-ounce styrofoam bowl of artichoke-and-kale soup cooling on a dinner cart in the break room of Dr. Patrick Yassini’s office, which is located next to Sharp Coronado Hospital. It’s a scene familiar to many doctors — just moments ago, Dr. Patrick Yassini rushed out to attend to a patient.

Unlike other doctors, however, Yassini is off to see one patient only. He does not feel the mounting pressure to process, examine, diagnose, and get that patient out the door so he can move on to the other five or six patients in adjacent exam rooms or out in the waiting room. This is because Yassini practices medicine at his own pace — anywhere between a few seconds for a prescription refill, to a ten-minute visit, to an hourlong session which might include a full exam, tests, even time to chat and answer questions about more than what hurts at the moment.

The present visit is brief. After a quick question from a patient and a look at the vitals, Yassini returns to the break room. He sits in a chair in the corner. Cradling the bowl of soup in one hand, he blows on it, and, half smiling, gingerly spoons a bit of the soup into his mouth.

Yassini is a family doctor, and he calls his practice Total Priority Care. He offers a raft of services, everything from sports and occupational medicine to weight management and skin care. Yassini examines mostly Coronado residents, youngsters, young adults, career-makers, homemakers, retirees — practically anyone with a pulse. This, for Yassini, is the perfect clientele. Rather than work with insurance companies, he charges patients an annual membership fee according to a sliding scale based on age. The scale starts at $1200 for patients 18 or younger and tops out at $2400 for patients 50 and over. Yassini is one of a handful of direct-pay doctors in San Diego intent on sheering off the rivets from boilerplate “patient care” with a new model of medicine based on an old set of criteria.

What these doctors practice has been described in different ways — concierge, subscription-based, direct-pay — but whatever it’s called, Yassini hopes his patients see this not as savvy pay-as-you-go lip-service but as part of a sincere effort to let the physician’s healing hands do the talking when it comes to quality healthcare.

With this approach, Yassini explains, doctor and patient agree to bypass the insurance system — any insurance system, private or government-sponsored. Wishing a polite yet firm pox on both their houses, Yassini enters into a one-on-one financial and medical relationship with his patients. He offers a third voice in the debate over healthcare by delivering a calculus of liberal personal care and conservative financial management, which, proponents claim, yields better results.

Come as you are

Yassini’s practice is on Coronado’s south end, in a medical park located on the same palm- and live-oak-shaded street as Sharp Coronado Hospital. Up two half-flights of stairs, there is a spacious waiting room surrounded by a suite of doctors’ offices. These have been leased by independent and group practices.

Dr. Patrick Yassini

IMAGE BY HOWIE ROSEN

While the chairs in the waiting area are three-quarters full this morning, none outside Yassini’s reception window are occupied.

At the front desk, Yassini’s two staff members greet patients on their way in. Denise Lloyd and Haifa Libed serve double-duty as nurses and receptionists, and, in Lloyd’s case, triple duty as bookkeeper for the practice.

It’s midmorning and Yassini is seeing his first patients of the day. Among them is retired special-needs teacher Lee Booth, who has been coming to Yassini since the day he saved her life.

A resident of Scripps Ranch, Booth is a small woman with a fierce smile and gentle grayish-blue eyes that seem to say I’m still alive, and, well, that’s all there is to it.

“I was brought into the emergency room here with a failed liver and kidney, at Dr. Yassini’s request,” she explains. A special-education teacher at Decatur High School in Seattle, Booth fashioned a career out of making herself clear to students. Upon retirement in 1992, she was drawn south to San Diego’s better weather.

Her husband, Booth says, began to see Yassini as his personal physician soon after the couple arrived in San Diego. Hearing good reports about the new doctor, Lee was considering switching when events forced the issue.

“I was going to switch over to Dr. Yassini even before this all happened,” she says.

“This all” is Lee’s way of describing the liver and kidney failure, an alcohol-induced crisis, which, compounded by diabetes, crippled her body’s filtration systems and nearly killed her. Almost as an aside, she mentions that she’s a breast-cancer survivor.

”When I came into the emergency room, the doctors told me they probably couldn’t keep me alive through the day. So, it was ten days in the hospital and the understanding that they were going to do a transplant — which I ended up not having.”

A recovering alcoholic, Booth says that excessive consumption induced her body’s various organs to put up a white flag against the daily abuse.

“I was told that, if I ever had another drink, I wouldn’t be alive, and I was lucky that they got me through that.”

Other doctors, she claims, never picked up on the heavy alcohol use that increased after she retired from teaching.

“It was a daily thing that went on mainly in the nighttime because, obviously, I was a teacher and would work. Then, when I retired, it was pretty much from eight in the morning onward.”

Lee says it wasn’t AA or rehab that eased her down the road to recovery; it was Dr. Yassini’s custom-made treatment program. From the moment he met her in the emergency room, he’s helped her every step of the way.

“In rehab centers or AA, you deal with the emotions. But there’s a lot going on medically, which is why they’re thinking relapses are happening so much [among alcoholics]. People don’t get retrained in their thinking and don’t understand what’s going on in the thought processes when you’re drinking that much.”